桡骨远端骨折术中切线位透视检测螺钉穿出的研究

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Abstract Objective To explore the sensitivity and specificity of tangential fluoroscopy in detecting screw perforation in distal radius fractures.Methods From January 2016 to September 2017，patients with distal radius fracture treated by open reduction and volar plate internal fixation in our hospital were selected and divided into two groups according to the following two criteria according to intraoperative fluoroscopy.①A total of 131 patients with suspicious perforation of distal radius screw through the articular surface were selected as the anterolateral incision group by standard anterolateral fluoroscopy，and then the anterolateral incision fluoroscopy of distal radius was performed.②A total of 115 patients with suspicious screw penetration through the dorsal cortex were selected as the dorsal incision group by standard lateral fluoroscopy，and then the distal radius dorsal incision fluoroscopy was performed.Three-dimensional CT scans of wrist joints were performed in both groups about 3 days after operation.The sensitivity and specificity of the anterolateral and dorsal cuts were analyzed.At the same time，according to the results of three-dimensional CT scans，the number of screw penetrating the dorsal cortex was calculated，and which quadrant the screw penetrating the dorsal cortex was located.Results①The sensitivity and specificity of the tangential position for detecting the non-perforated and perforated articular surfaces of the screw were 98.26%and 81.25%respectively in the positive and lateral incision group，according to Gartland-Werley Wrist Function Score，the excellent and good rate was 79.05%.②The sensitivity and specificity of tangential screw detection in the dorsal section group were 99.01%and 85.71%respectively，which did not penetrate the dorsal cortex and penetrated the dorsal cortex.A total of 441 distal radius screws were inserted into the distal row （i.e.near the articular surface）.The screw positions were scanned by CT：the first room （48，10.88%），the second room （144，32.65%），38，the third room （163，36.96%），0，the fourth room （86，19.50%）and 9.Conclusion The tangent position is highly reliable for judging the screw penetrating the articular surface and the dorsal cortex of the distal radius fractur.The screw penetrating the dorsal cortex is mainly located in the second and fourth compartments，which has certain guiding significance for judging the length of the screw during the operation.

Key words： Distal radial fracture Tangential position Screw

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